Crown Lengthening Procedure Research Articles

Apically Positioned Flap Technique for Crown Lengthening Procedure

Apically Positioned Flap Technique for Crown Lengthening Procedure

Aesthetic surgical crown lengthening on teeth 11 and 21

Background: In dental treatment planning, aesthetic considerations are crucial due to the relationship between a smile and facial beauty. Crown lengthening is a procedure used to achieve aesthetic smiles, particularly in cases of subgingival caries, fractures, and short clinical crowns. Purpose: The purpose of this case report is to achieve aesthetic improvement of the central incisors through crown lengthening procedures. Case: A 31-year-old female patient presented with a complaint of a broken upper left front tooth and easily bleeding gums. Clinical examination revealed Ellis class 1 fracture at the incisal-distal of tooth 21. The patient exhibited poor oral hygiene with visible calculus on upper and lower jaw teeth. There was gingival hyperplasia, redness, bleeding tendency, and the gingival margin height of teeth 11 and 21 appeared lower than teeth 12 and 22. Radiographically, the alveolar crest was distant from the CEJ. Case Management: Treatment plan included crown lengthening on teeth 11 and 21 with composite restoration on tooth 21. Crown lengthening, a surgical procedure designed to increase the extent of supragingival tooth structure for restorative or aesthetic purposes by repositioning the gingival margin apically was performed. This procedure is indicated for teeth with subgingival caries, extensive caries shortening the tooth, fractures, and short clinical crowns. Conclusion: Crown lengthening should consider the biological width to prevent bone resorption, gingival recession, inflammation, or hypertrophy. When performed under ideal clinical conditions, crown lengthening provides satisfactory outcomes both functionally and aesthetically.

Soft Tissue Retraction Maneuver in Cone Beam Computed Tomography Prior to Crown-Lengthening Procedure-A Technical Note.

Background: An accurate determination of the biological width and the relationship of the cemento-enamel junction with the border of the alveolar bone is crucial during a clinical crown-lengthening (CCL) procedure. The aim of this study was to present a technical note about the retraction techniques in cone beam computed tomography (CBCT) prior to CCL, highlighting the significant enhancement in procedural accuracy and predictability that these techniques offer. Methods: Clinical and radiological examinations should be performed before a CCL procedure. It is necessary to determine the length of the tooth crowns, the periodontal pockets' depth, and the phenotype of the gingiva. The ideal CBCT examination should be performed with soft tissue retraction. This can be achieved using retractors or cotton rolls. Results: Retraction of the lips, cheeks, and tongue allows one to assess the marginal gingiva, the cemento-enamel junction, and the alveolar bone. A detailed plan of the CCL procedure, which involves retraction, ensures both the aesthetic appeal and the achievement of a newly defined gingival zenith, enhancing the overall visual harmony. Conclusions: Compared with conventional radiographic imaging, the soft tissue retraction maneuver in CBCT prior to CCL surgery offers an effective approach to the evaluation and diagnosis of soft and hard tissue. This is because of the detailed planning of the aesthetic CCL procedure. Such an approach leads to superior aesthetic outcomes in dentistry, contributing to the advancement of aesthetic dentistry through a harmonious blend of art and science.

Survival analysis of teeth following clinical crown lengthening and crown insertion procedures up to 14 years: A retrospective cohort study.

The purpose of this study was to conduct survival analysis of teeth following clinical crown lengthening procedures (CLPs) and crown insertions via a retrospective cohort study. Patient- and tooth-related data were collected from 268 participants who received CLPs from 2009 to 2015. The Kaplan-Meier curve and the log-rank tests were used to estimate the probability of survival and compare the survival probabilities among different variables. A Cox multivariate proportional hazard regression model was used to investigate the collective effects of root canal treatment (RCT) and the types of opposing dentition. The rate of tooth loss was 21.6% during the observation period from 1 to 14 years, with 58 teeth extracted. The most attributable reason for tooth extraction was coronal tooth fracture, followed by endodontic failure such as root fracture. The survival probability was 0.87 at 5 years and 0.7 at 10 years. No significant differences in the survival probabilities were found among different providers and locations, the presence of a post, and the types of crowns. The hazard ratio for tooth loss was 6.3, 95% confidence interval (CI) [2.6 to 20.9] in the teeth with RCT (p<0.001) and 2.4, 95% CI [1.1 to 4.8] in the teeth occluding implant-retained prostheses (p=0.016). Tooth loss following CLPs and crown insertions appeared least among the teeth without RCT when occluding natural teeth, while tooth loss was most among the teeth with RCT when occluding implants.

Influence of crown-lengthening surgery on teeth rehabilitated with ceramic single crowns: A 12-month prospective clinical study

ObjectiveTo compare the clinical periodontal parameters of teeth restored with a single ceramic crown, with and without crown lengthening procedure. MethodsThis prospective, longitudinal, controlled, and single-blinded clinical trial involved 22 patients with a total of forty-one teeth with ceramic crowns. The teeth were divided into two groups: test (n = 21), comprising teeth rehabilitated post crown-lengthening surgery, and control (n = 20), comprising teeth rehabilitated without crown-lengthening surgery. Plaque index (PI), gingival index (GI), probing depth (PD), bleeding on probing (BoP), and clinical attachment level (CAL) were compared between groups (surgically treated and non-surgically treated) and within each group for each type of site (treated -tt; adjacent – ad; and nonadjacent - nad). Additionally, gingival phenotype (GP), gingival recession (GR), and keratinized tissue width (KTW) were also assessed post- restoration. Statistical analyses used a significance level set at 5 %. ResultsPI, GI, and BoP were reduced, but no statistically significant differences were observed within each group or between groups for most follow-up periods. CAL of the TT sites was consistently higher in the test group, and PD was also higher in the test group (p < 0.05), except at T3. adPD, nadPD, adCAL, and nadCAL demonstrated no significant differences between groups and periods. A significant association was identified between GP and the occurrence of GR, with the thick-flat phenotype demonstrating less association with GR, regardless of whether crown lengthening was performed or not. ConclusionCrown-lengthening surgery in rehabilitated teeth does not significantly affect PI and GI after 12 months. Although crown-lengthening surgery affected PD and CAL in TT sites, it did not affect adjacent and non-adjacent sites. Clinical relevanceThese findings emphasize the importance of considering individual patient factors and the potential impact on periodontal tissues when planning crown-lengthening surgery. Clinicians must have a comprehensive understanding of the dynamics of the periodontal tissues involved in restorative treatments to optimize the procedure, increase success rates, and minimize potential complications.

Biologic Width Following Different Crown Lengthening Procedures: A Six-Month Follow-Up Study.

One of the important things to preserve during crown lengthening is the biologic width (BW), recently called supracrestal tissue attachment. A healthy periodontium with adequate BW is very essential for the success of restored teeth. There are various techniques to perform crown lengthening procedures. Most of the studies have focused on assessing the changes in the position of the marginal gingiva and bone as outcome parameters rather than BW. Also, most of the research was done on animal models. The purpose of this study was to assess the periodontal tissue changes at three months and six months following two different surgical crown lengthening procedures. Sixty mandibular first molars among 60 patients that required surgical crown lengthening were enrolled in the study and subjected to two different procedures, gingivectomy (Group I; n=30) and apically positioned flap with ostectomy (Group II; n=30). The following parameters were recorded at baseline, three months, and six months, position of free gingival margin (FGM), probing depth (PD), relative attachment level (RAL), bone level (BL), and BW. These measurements were made at three sites in every patient: treated tooth sites (TT), adjacent tooth's adjacent sites (AD), and adjacent tooth's non-adjacent sites (NAD). The data was then subjected to statistical analysis using SPSS software (Version 20.0). Statistical significance was set to p<0.05. When groups I and II were compared at three and six months, there was no statistical difference in terms of position of FGM, PD, and RAL (p>0.05). When BW was compared between the two groups at three and six months, group II showed better reestablishment of BW at any given time period and was statistically significant (p<0.05). Following surgical crown lengthening, the bone level was shifted apically and allowed for the reestablishment of BW. At six months of follow-up, the apically positioned flap with ostectomy was superior in restoring the BWcompared to gingivectomy.

LASER-ASSISTED CROWN LENGTHENING: CLINICAL EFFICACY AND ADVANTAGES OVER CONVENTIONAL TECHNIQUES (SYSTEMATIC REVIEW)

Introduction: Crown lengthening is a widely recognized dental procedure with both aesthetic and functional purposes. It involves the reduction of periodontal hard and soft tissues to obtain supracrestal tooth length, resulting in longer clinical crowns and adequate supracrestal tissue attachment. Laser therapy has emerged as a promising alternative that is currently developing in the field of periodontics and offers several advantages. This review aims to synthesize the current research on the clinical efficacy of laser-assisted crown lengthening procedures and highlight their advantages over conventional methods. Review: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive search was conducted in electronic databases PubMed, Scopus, Embase, and Google Scholar for human studies published from 2017 to April 2023. Out of 213 identified and screened studies, three original articles were included in the analysis. Two clinical trial studies used Er,Cr:YSGG while one study used Er:YAG for crown lengthening procedures involving gingiva and alveolar bone reduction, with a 3-month follow-up period. Compared to conventional crown lengthening, the laser-assisted approach showed comparable increases in clinical crown length. However, the laser-assisted group demonstrated better gingival margin stability, improved soft tissue healing, and minimal damage to adjacent tissues. Furthermore, there was a statistically significant lower bacterial load and less post-surgery pain with laser-assisted crown lengthening compared to the conventional method. Conclusion: In cases where both gingival and bone reduction are required, laser-assisted crown lengthening using Er,Cr:YSGG and Er:YAG can be considered a minimally invasive alternative with several advantages over conventional procedures.

Biological shaping as a conservative alternative for crown lengthening: A review.

The perio-restorative approach to maintaining supracrestal tissue attachment (STA; formerly known as biologic width) is a fundamental goal in modern dentistry. This article aims to review the clinical impact of biologic shaping (BS) as an innovative alternative to traditional crown lengthening procedures, reflecting over two decades of clinical experience. As a review paper, it is crucial to highlight that BS stands as a unique approach designed to optimize STA while emphasizing minimal to no removal of supporting bone. The review spans over two decades, consistently demonstrating clinical efficacy and predictability. Remarkably, BS focuses on addressing issues such as root concavities, developmental grooves, irregularities, furcation lips, and CEJ offering a remarkable level of clinical precision. The reviewed literature underscores that BS has consistently achieved substantial clinical success in fulfilling its objectives. This method presents a biologically sound alternative to traditional crown lengthening, placing a strong emphasis on the preservation of essential bone tissue and the establishment of durable STA. The results suggest that BS is a logical and biologically driven approach for maintaining STA, making it a promising alternative to traditional crown lengthening. The method offers a predictable and reproducible way to preserve bone tissue while achieving durable STA. This innovation holds great promise in the field of periodontal and restorative dentistry.

Facially driven guided crown lengthening using a complete digital workflow: A dental technique

A facially driven digital guided crown lengthening method using the virtual smile design approach supplemented with a static 3-dimensional face scan that demonstrates the digital data of extraoral soft tissue is presented. The technique enables the practitioner to virtually design the new smile and surgically plan the crown lengthening procedure.

Staged esthetic crown lengthening: Classification and guidelines for periodontal-restorative therapy.

This article presents technical guidelines for perio-restorative esthetic crown lengthening, along with a discussion of the biologic rationale. A classification system is proposed to assist in treatment planning and sequencing the surgical and restorative phases. When esthetic crown lengthening is performed as an adjunct to restorative therapy, the surgical approach must be determined by the anticipated position of the restorative margins. The removal of sufficient bone to achieve the desired clinical crown length and preserve the supracrestal gingival tissue dimensions is facilitated by the use of a surgical guide fabricated according to the design of the restorations. A staged approach allows sequencing the provisional restoration to minimize unesthetic sequelae during the healing period. Inadequate bone resection and/or alteration of the soft tissue dimensions results in delayed healing, leading to coronal gingival rebound and biologic width impingement. The identification and preservation of appropriate restorative and biologic landmarks is essential for success in pre-prosthetic esthetic crown lengthening treatment. A staged approach improves the esthetic management during the postsurgical healing and maturation period. A restorative driven classification system for sequencing and staging adjunctive esthetic crown lengthening procedures is presented. Technical guidelines to enhance gingival margin predictability are suggested, accompanied by relevant evidence. In addition, wound healing timelines following gingival and osseous resection are provided.

Crown Lengthening by Conventional Diode Laser and Blue Laser: A Randomised Clinical Trial

Introduction: Crown lengthening is a reliable procedure that enables the restoration of teeth with a short clinical crown, extensive subgingival caries, and correction of excessive gingival display for aesthetic purposes. Blue laser, a recent technology in dentistry, has shown significant effectiveness at low power settings, promoting favourable wound healing effects. Aim: To compare the Visual Analogue Scale (VAS) scores and wound healing outcomes between blue laser and denlase in performing crown lengthening procedures. Materials and Methods: A randomised clinical trial was conducted in the Department of Periodontics and Implantology, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India, involving 14 patients who were divided into two groups. Participants were recruited from September 2021 to April 2022. Ethical clearance was obtained from the Institutional Ethics and Review Board. Group-A underwent crown lengthening using blue laser (445 nm), while Group-B received treatment with denlase (980 nm). VAS scores and the wound healing index were recorded and compared between the two groups at baseline, 10 days, and one month after the surgery. Statistical tests such as the Mann-Whitney U test, unpaired t-test, and repeated measures ANOVA were used for analysis. Results: The study revealed a statistically significant difference (p-value=0.006) in VAS scores between the blue laser group (mean value of 0.5) and the denlase group (mean value of 1.3). However, statistically significant differences in Wachtel’s early wound healing index were not observed in either of the groups. Conclusion: Blue laser treatment was found to be more comfortable for patients, as indicated by the lower VAS scores. Both groups demonstrated good wound healing properties based on Wachtel’s early wound healing index, with no significant difference between them. It is important to note that literature on blue laser technology is still in its early stages and requires further comprehensive investigation.

Effects of the GingivalStat approach on early gingival margin remodeling following esthetic clinical crown lengthening: A case series.

The aim of this case series is to present the potential applications of the GingivalStat approach, that is, the use of temporary gingival stabilizers, to favor early gingival margin remodeling and prevent the occurrence of gingival rebound following esthetic clinical crown lengthening. Four patients requiring clinical crown lengthening were treated for esthetical and functional reasons. The surgical approach included: (a) gingival margin recontouring; (b) full-thickness flap elevation; (c) osteotomy (to achieve an adequate dimension between the alveolar bone crest and the CEJ) and osteoplasty (to reduce the bone thickness and improve the buccal bone anatomic profile, where indicated); (d) temporary gingival stabilizer placement using a block-out resin or a composite (the GingivalStat approach); and (e) flap repositioning, adaptation, and suture. One- to five-year follow-ups, reported in the different case scenarios, show evidence of clinically stable gingival margins around the treated teeth. Within the limits of this case series, it can be concluded that the GingivalStat approach appears as a further maneuver to cope with clinical crown lengthening procedures at esthetic sites. GingivalStat seems to favor gingival margin contour remodeling during the early phase of healing as well as prevent the occurrence of gingival rebound. GingivalStat approach may guide gingival margin remodeling and prevent gingival rebound after wound healing of sites submitted to esthetic clinical crown lengthening.

Evaluating the prospective crown-root ratio after extrusion and crown lengthening procedures in vitro

For restoration of extensively damaged teeth preprosthetic treatment measures are necessary. Crown lengthening and extrusion affect the prospective crown-root ratio (CRR). The subject of this in vitro study was to compute CRRs for both treatment approaches. 120 human maxillary central extracted incisors were measured. Measurements were calculated for five treatment groups: C (control), E-2 mm (extrusion of 2 mm), E-4 mm (extrusion of 4 mm), CL-2 mm (crown lengthening of 2 mm), and CL-4 mm (crown lengthening of 4 mm). Tooth (TL), root (RL), and crown lengths (CL) were measured from mesial (m) and facial (f) cemento-enamel junction (CEJ), and respective anatomic (CRR) and effective crown-root ratios (eCRR) were calculated. Following CRR values were computed for C: CRR-m = 0.4 ± 0.1, CRR-f = 0.7 ± 0.1. All crown-root ratios were lower (more favourable) for extrusion compared to crown lengthening (p < 0.001). ECRRs were higher than anatomic CRRs. CRR at mesial CEJ was significantly lower than CRR with facial CEJ as reference (p < 0.001). Mesial measurement-based calculations of CRR typically based on radiographic images should be interpreted with caution as they underestimate the eCRR. CRR can be expected as lower, i.e. more favourable, when teeth are extruded than crown lengthened.

Comparative analysis of the trueness of linear measurements using direct and indirect scanning protocols compared to actual clinical measurements.

To assess the trueness of digital measurements using direct and indirect scanning approaches compared to the actual clinical measurements. The crown length, width, and width/length ratio were measured in 36 anterior maxillary teeth using three different methods. The first was clinically using a digital caliper, the second was by scanning the teeth using a digital scanner and the third was by making an impression of the teeth, constructing a stone cast in the lab, and scanning it to obtain digital measurements. Bland-Altman test and intraclass correlation were used to assess the data and make comparisons. Measurements taken using both approaches were highly reliable, with intraclass correlations ranging from 0.934 to 0.977 (p ≤ 0.000). Bland-Altman plot reflected a minimal mean difference between measurements especially in crown width measurements. Crown width/crown length measurement displayed the highest mean difference. Both direct and indirect optical surface scans showed similar high trueness in linear measurements of teeth. A higher discrepancy was detected in the crown width/length ratio. Digital dentistry is the new era in patient management. The use of conventional impression techniques and physical dental casts is associated with several disadvantages. Scanning dental casts to convert physical records into digital ones has multiple advantages. Optical surface scans (digital models) of the dentition are currently being more broadly used and advocated in the different dental disciplines including the construction of surgical guides for esthetic crown lengthening procedures. The trueness and reliability of linear measurements are of paramount importance to allow for proper fit and predictable outcomes. In this study, the trueness of these linear measurements obtained using direct and indirect methods was compared to the actual clinical measurements.

Effect of periodontal surgery on the salivary Herpes simplex virus-1 levels-a pilot study.

Herpes simplex viruses (HSV) are one of the most important groups of human pathogenic viruses. The prominent characteristic of this virus is latency and the ability to reactivate. One of the possible factors for reactivation of this virus is dental procedures. The aim of this study was to evaluate the salivary level of Herpes simplex viruses, before and after periodontal (crown lengthening) surgery and its relation with age and sex. 30 HSV seropositive patients, who needed the crown lengthening surgery and accepted to cooperate in this research, were included as experimental group of this study. Unstimulated Saliva samples of the patients were collected in 1.5ml micro-tubes, before and 24h after the surgery, and were analyzed by Premix EX taq probe qpcr, using PCR real-time method. No significant statistical differences were observed in the salivary level of HSV before and after crown lengthening procedure (p=0.18). However, the level of HSV in saliva after surgery was significantly higher than its level before surgery in women as compared to men (p=0.003). The differences in virus level did not have any significant relationship with patients' age (p=0.9). It seems that periodontal (crown lengthening) surgery does not affect the level of HSV in saliva yet, but it could be one of the stimulators of increased HSV level after surgery in women as compared to men; but age does not play an important role in changes of level of virus before and after the surgery.

Multifunctional anatomical prototypes (MAPs): Treatment of excessive gingival display due to altered passive eruption.

To describe a strategy using digital technologies for improving the diagnosis, treatment planning, and surgical execution of patients with excessive gingival display (EGD) due to altered passive eruption (APE). An important component for successful patient's management is to fulfill their esthetic expectations whilst delivering predictable and long-term therapeutic outcomes. To achieve this goal in patients with excessive gingival display due to altered passive eruption, it is essential to perform an accurate diagnosis and to communicate to the patient the expected customized results using digital technologies. Computer-aided designed and manufactured multifunctional anatomical prototypes (MAPs) may contribute to these purposes. Additionally, they can guide the surgical crown lengthening procedure or serve as a reference during the surgical guide fabrication providing information of the required anatomical landmarks. This novel strategy protocol for diagnosis, communication, and treatment management of patients with excessive gingival display follows functional and biological principles within the frame of a digital workflow, which improves the diagnostic capabilities, enhances communication, and guides the surgical treatment as shown in the 12 months follow-up of the reported case. Developing a virtual patient by combining multiple digital data sets including cone-beam computed tomography (CBCT), intra-oral scans and digital photography, supports the clinician and the patient to achieve a comprehensive diagnosis and to better communicate the expected results to the patient. Furthermore, this digital treatment exercise based on anatomical and biological principles will facilitate the surgical precision and the achievement of successful outcomes, thus fulfilling the patient needs and expectations.

A case report: Surgical esthetic crown lengthening procedure for gummy smile treatment

Background: In modern society, a harmonious smile is considered a symbol of beauty. An attractive smile can improve appearance so that a person is more easily accepted in society. In planning dental treatment to be carried out, aesthetic considerations are very relevant because of the relationship between smile and facial beauty. Purpose: The purpose of writing this article is to describe a crown lengthening accompanied by bone reduction to correct an excessive gingival display in a patient with altered passive eruption (APE) of the maxillary anterior teeth. Case: A 28-year-old female patient came to the Periodontology Specialist Polyclinic at RSGM Airlangga University with complaints that the gums on the upper front teeth looked more dominant. The patient did not have problems with the periodontal tissue and had no history of systemic diseases such as diabetes, high blood pressure, and had no history of allergies to food and drugs. Case Management: After analyzing the periodontal tissue, the choice of crown lengthening with bone reduction was chosen to treat this case. Conclusion: procedures Crown lengthening have been performed as a viable option to facilitate restorative therapy or improve esthetic appearance.

Simultaneous Esthetic Crown Lengthening and Frenotomy Procedure for Smile Rejuvenation

&#x0D; Introduction: Gingival tissue plays an important role in smile aesthetics, especially in the anterior maxillary region. A gummy smile (GS) is a gingival condition that appears excessive when the patient smiles. The prevalence of gummy smile in individuals aged from 20 to 30 is 10% of population. It is more common in women and can cause aesthetic problems. Gummy smile aetiology is multifactorial. This case report discusses gummy smile case caused by altered passive eruption (APE) and associated with the presence of aberrant frenum. Case Report: A 19-year-old female patient with chief complaints of the excessive gingival display. The diagnosis of the case was confirmed by clinically healthy gingiva in an intact periodontium with gummy smile due to the presence of altered passive eruption type I-B accompanied by an aberrant frenum. The final surgical plan was aesthetic crown lengthening (CL) with flap surgery and osteotomy simultaneous with a frenotomy. Conclusion: The aesthetic crown lengthening surgery and frenotomy can be performed simultaneously to correct the gummy condition and improve the patient’s smile profile. Appropriate examination, diagnosis, and treatment planning help achieve optimal patient outcomes.

Gummy smile to esthetic smile – Crown lengthening procedure

Gummy smile to esthetic smile – Crown lengthening procedure

Surgical Crown Lengthening: Restoring Aesthetics and Function

Short clinical crown affects appearance and retention of the restoration placed within aesthetic zone. Thereafter, Surgical crown lengthening procedure is done to increase crown length for restorative or aesthetic reasons without breaching the biologic width. Herewith, we present a case of crown lengthening procedure along with osseous reduction on maxillary anteriors in a 25 years female patient referred to our department which resulted harmonious appearance and symmetry of tissues on follow up. Aesthetic crown lengthening procedure can be challenging. So, appropriate case selection with accurate diagnostic and interdisciplinary approach are essential for getting enhanced and conservative results in aesthetic areas.